Time Course of Change in Blood Pressure From Sodium Reduction and the DASH Diet.
Time Course of Change in Blood Pressure From Sodium Reduction and the DASH Diet.
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DOI：
10.1161/hypertensionaha.117.10017
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发表时间：
2017-11
期刊：
影响因子：
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通讯作者：
Appel LJ
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文献类型：
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作者：
Juraschek SP;Woodward M;Sacks FM;Carey VJ;Miller ER 3rd;Appel LJ
减少钠和DASH饮食都能降低血压（BP）;然而，随着时间的推移，它们对BP的影响模式尚不清楚。在DASH-钠试验中，未使用降压药物的1期高血压患者被随机分配到典型的美国饮食（对照）或DASH。在他们指定的饮食中，参与者在4周内随机食用三种钠水平（50，100和150 mmol/d，2100 kcal）。在12周内每周测量血压; 412名参与者入组（57%女性，57%黑人，平均年龄48岁，平均SBP/DBP 135/86 mmHg）。对于那些被指定为对照组的人，高钠饮食组的SBP/DBP在第1周和第4周之间没有变化（每周变化为-0.04/0.06 mmHg/周），而低钠饮食组的血压则逐渐下降（-0.94/-0.70 mmHg/周; SBP和DBP的时间和钠之间的P-相互作用<0.001）。对于那些被分配为DASH的人，高钠饮食的SBP/DBP变化为-0.60/-0.16 mmHg/周，而低钠饮食的SBP/DBP变化为-0.42/-0.54 mmHg/周（SBP和DBP之间的时间和钠之间的P-相互作用=0.56和0.10）。当比较DASH与对照组时，DASH在1周后使SBP/DBP改变了-4.36/-1.07 mmHg，这是观察到的大部分效应，SBP（P-相互作用=0.97）或DBP（P-相互作用=0.70）的每周变化率无显著差异。在典型的美国饮食的背景下，低钠饮食降低了血压而没有平台，这表明钠减少的全部效果在4周内并没有完全实现。相反，与对照组相比，DASH在一周内降低了血压，此后没有进一步的影响。
Both sodium reduction and the DASH diet lower blood pressure (BP); however, the patterns of their effects on BP over time are unknown. In the DASH-Sodium trial, adults with pre-/stage 1 hypertension, not using antihypertensive medications, were randomly assigned to either a typical American diet (control) or DASH. Within their assigned diet, participants randomly ate each of three sodium levels (50, 100, and 150 mmol/d, at 2100 kcal) in 4-week periods. BP was measured weekly over 12wks; 412 participants enrolled (57% women, 57% black, mean age 48years, mean SBP/DBP 135/86 mmHg). For those assigned control, there was no change in SBP/DBP between weeks 1 and 4 on the high sodium diet (weekly change −0.04/0.06 mmHg/week) versus a progressive decline in BP on the low sodium diet (−0.94/−0.70 mmHg/week; P-interactions between time and sodium <0.001 for SBP and DBP). For those assigned DASH, SBP/DBP changed −0.60/−0.16 mmHg/week on the high versus −0.42/−0.54 mmHg/week on the low sodium diet (P-interactions between time and sodium=0.56 for SBP and 0.10 for DBP). When comparing DASH to control, DASH changed SBP/DBP by −4.36/−1.07 mmHg after 1wk, which accounted for most of the effect observed, with no significant difference in weekly rates of change for either SBP (P-interaction=0.97) or DBP (P-interaction=0.70). In the context of a typical American diet, a low sodium diet reduced BP without plateau, suggesting that the full effects of sodium reduction are not completely achieved by 4wks. In contrast, compared with control, DASH lowers BP within a week without further effect thereafter.